Primary Prevention of Coronary Artery Disease

There have been an estimated one million deaths from cardiovascular disease in sub-Saharan Africa in 2013. The deaths can in some part be prevented through the control of risk factors for coronary artery disease. The major modifiable risk factors in adults include: smoking, obesity, unhealthy diet, dyslipidaemia, hypertension and diabetes. This article aims discuss the primary prevention of coronary artery disease through examining the evidence regarding the control of these modifiable risk factors. It also briefly explains a pragmatic approach to the use of aspirin as primary prevention for coronary artery disease which takes into account both the risks and benefits associated with aspirin use

Use of angiotensin receptor – neprilysin inhibitors in heart failure: a paradigm shift

Heart failure is a clinical syndrome responsible for at least one-third of hospitalisations amongst cardiac patients, with escalating mortality and healthcare costs on both public and private health care. Both prevalence and incidence of heart failure increase steeply with advancing age, making it a growing public health problem. Pathophysiologically, heart failure clinically presents in two common forms: heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. The cornerstone of heart failure management includes the use of angiotensin-converting enzyme inhibitors. A recently developed pharmacotherapy that inhibits both the angiotensin receptor and the enzyme neprilysin has shown promise in the management of heart failure with reduced ejection fraction. This article will highlight the impact of this new therapy and its potential use in heart failure with reduced ejection fraction

Management of Cough: a practical approach

On a regular day, healthcare providers will be contacted by one or more health seekers presenting with cough as a symptom. Cough has been considered an important physiological reflex that protects the airways from aspiration of foreign materials. Cough is one of the most common symptoms for which people seek medical attention from their healthcare practitioners. The common classifications for cough include acute, subacute and chronic cough. Such classification is time dependant. Acute cough is generally self-limiting, while subacute and chronic coughs have various different causes. There are many different causes of cough, and the common causes of persistent coughs include: upper airway cough syndrome, asthma, gastroesophageal reflux disease (GORD) and even pharmacological therapy. There are other important causes of chronic cough especially in the Southern African region that include: pulmonary tuberculosis (TB), environmental diseases, and others, which will not be covered by this article. Management of subacute and chronic coughs should be individualised according to their cause. Currently, there is no evidence to suggest acute coughs need to be treated. Moreover, there is poor evidence to recommend the use of over the counter (OTC) cough syrups in the management of acute coughs

Long-acting reversible hormonal contraception

Long-acting reversible hormonal contraceptives are effective methods of birth control that provide contraception for an extended period without requiring user action. Long-acting reversible hormonal contraceptives include progesterone only injectables, subdermal implants and the levonorgestrel intrauterine system. These methods have several advantages over other reversible contraceptive methods. More importantly, once in place, they require minimal maintenance and their duration of action ranges from 8 weeks to 5 years. Despite the advantages of long-acting reversible hormonal contraceptive methods, they are infrequently used in South Africa. Short-acting methods, specifically oral contraceptives and condoms, are by far the most commonly used reversible methods. A shift from the use of short-acting methods to long-acting reversible contraceptive methods could help reduce the high rates of unintended pregnancies in South Africa. In this review of long-acting reversible hormonal contraceptive methods, we discuss the long-acting progesterone injectables, the etonogestrel implant and the levonorgestrel intrauterine system available in South Africa, the side effects of each of these preparations and the non-contraceptive benefits. It is imperative that health professionals and educators inform women of reproductive age about the benefits, risks, and common side effects of long-acting reversible hormonal contraception to improve consideration and recognition of these methods